Tom Blumer from BizzyBlog has updated his map of the ObamaCare/PelosiCare behemoth and what it creates. Namely 111 agencies, regulators, committees, boards and offices: (click on picture to enlarge)
Meanwhile Senator Gregg reacts to the new CBO estimate:
Senator Judd Gregg (R-NH), ranking member of the Senate Budget Committee today commented on the Congressional Budget Office’s (CBO) more detailed cost estimate of the manager’s amendment to the House health reform bill.
Senator Gregg stated, “The CBO estimate released last night finally sheds light on the smoke and mirrors game the majority has been playing with the cost of their health care reform proposal. Over the first 10 years, this legislation builds in gross new spending of $1.7 trillion – and most of the new spending doesn’t even start until 2014. Once that spending is fully phased in, the House Democratic bill rings up at more than $3 trillion over ten years.
“Additionally, this bill cuts critical Medicare and Medicaid funding by $628 billion, accounts for nearly $1.2 trillion in tax and fee increases and will explode the scope of government by putting the nation’s health care system in the hands of Washington bureaucrats. The $3 trillion price tag defies common sense – we simply cannot add all this new spending to the government rolls and claim to control the deficit.
“If we continue to pile more and more debt on the next generation, they will never be able to get out from under it. The health care system needs reform, but this massive expansion of government, financed by our children and grandchildren, is the wrong way to proceed.”
And listen…this is what our government believes will be the cost. But look at programs our government has run historically and you find decades of added costs and overruns that our forced onto the taxpayer.
Insanity
Again, you did not read the language:
Again, I point out paragraph 1 as it relates to paragraph 3 above.
The way this language reads, if you want the consultations covered, there is a 5-year limitation… meaning use it, or lose it for coverage. I don’t care if colonoscopies are mandated or not. That’s nothing to do with *this* mandate. This, of course, is exactly the opposite of your personal interpretation:
I understand your interpretation of the language as it’s shared by every proponent of government provided health care, Larry. And in fact, the author of this bill section, Rep. Blumenauer, echoes that this was his intent with the language.
But again I remind you of your statement INRE doctors spending that extra 45 minutes to explain the risks/results of alternative treatment, and how lawyers exploit that in a court of law with vague legislative language.
Now one has to wonder, when implemented, who is correct? Would it have been exploited in the courts and denied coverage as interpreted as the same way I see it? Could they have potentially tied any treatment to the fact that someone refused such coverage and consultations?
The point is, the language is vague, and could be argued either way. And I’m generally one who tends to take the worst possible scenario as fact to avoid ugly surprises later.
It is also an unnecessary service/cost and provided by the wrong people, IMHO. It is not a service that is not unavailable via other avenues…. and for little to no cost.
Now let’s take another argument about this voluntary and/or mandated counseling that parallels with the unnecessary increased costs for services available for free elsewhere. This is from MedPage Today just a yesterday… pointing out that more pro-active patient mentality drives up costs unnecessarily.
Why, Larry, are you advocating increased costs for services offered for free elsewhere?
Now, let’s take another repercussion of such legislation… and this goes to the heart of your hatred for Sarah Palin. Quite frankly, I don’t think you understand her point. So let me reference some of her written testimony to the New York State Senate Aging Committee hearing.
Potential abuse, increased waste of funds for already provided services, and open to misinterpretation.
I rest my case.
And yes, I do know what a living will is… instructions INRE DNR. If that was Dad’s wishes, the last thing I wanted was for him to be taken to a hospital, put on life support, and force my mother to pull the plug. That is not something I’d want her to live with.
Powers of attorney (the 2nd arena of discussion) have everything to do with estate planning, unless that power of attorney is strictly limited to the living will. In fact, the legislative language specifically mentions durable power of attorney, which encompasses a considerably wider scope than merely DNR or medical decisions while incapacitated. It is not, as the legislation implies, merely a “health care proxy”. This advice can lead to empowering someone with far more decision making directives than the patient wants, and is best left to an attorney structuring just what they want that empowered person to be able to do.
Only an attorney can effectively limit the scope of power when constructing the POA, and therefore only an attorney should be providing legal advice. Doctors have no business practicing law.
A living will/DNR instruction isn’t the only “end of life” counseling, and includes minimally what to do about funeral arrangements, credit cards, social security notifications etal. The debris we leave behind in this world is immense.
Why should we drive up Medicare costs, paying medical professionals for small segment of genuine end of life counseling, when the larger scope of all involved is provided via other means? In fact, the legislation itself points out they have access to such via national toll-free hotlines, the advance care planning clearinghouses, and State legal service organizations.
Again why, Larry, are we adding to Medicare costs when this service is already available via free means?
This is all rather moot, when you think of it. This does not exist in the new bill, and these services are readily available via other channels. I see it as a waste of funding, and speaking with a medical professional about such is the last thing I’d want to do about such matters. All I’d want is, tell me what the treatments are (both what they would cover via Medicare, and what I could obtain OUTSIDE of Medicare, as the latter is often held back by the “wallet” mentality). Then let me make my decision.
I’ll figure out my own end of life plans without their help, thank you.
Mata, on this issue (the “mandate”) you are 100% wrong. Let me take you through it, step by step:
You quote me:
>>Larry W: The 5 year thing just means that, if you are in a stable condition and are not having changes in your health, you are entitled to such a consultation every 5 years. It’s no difference than Medicare saying you are entitled to have a colonoscopy every 5 years. There is no “mandate” to have a colonoscopy!<<
You say:
Yes I did.
What this means is that the rule for paying for end of life counseling does not apply to the initial physical examination and discussion for purposes of determining when the clock starts running on the proscription from providing counseling more than every 5 years. Let’s say that I get a new referral — breast cancer patient. During my initial evaluation, she asks me questions about living wills and advance treatment directives and so forth. I answer her questions. I take the total amount of time I spend with her (there is a formula for this) and bill medicare for a brief consultation or an extended consultation or a complex consultation or whatever. Even though we went over the living will/advance directive stuff, it doesn’t start the meter running. Let’s say that she decides not to have a living will.
Now, two years later, she hears something on Oprah which makes her decide that she might want to have a living will, after all. She makes an appointment with me solely to get more details on what sorts of specific medical procedures might come up in the future and which procedures she might want and which she might not want. So I spend 45 minutes explaining everything. Now, I am entitled to bill Medicare for end of life counseling, even though I did this 2 years previously, as part of my initial consultation, and even though it’s only 2 years later. However, at this point, the 5 year meter starts running. Let’s say that she goes ahead and gets with her lawyer and writes her living will. But then, another year or two later, she hears something on Larry King Live which makes her think she might want to revise her living will. She makes another appointment with me to discuss it. I can’t bill Medicare for end of life counseling, because it hasn’t been 5 years.
Now, let’s say that, one month after the above, she is passing dark urine and she comes in to see me and I diagnose metastatic breast cancer in her liver. She wants more counseling, because her condition has changed. I AM allowed to bill Medicare for this, even though it’s been less than 5 years since I last billed.
.
NO! You are WRONG! What that means is that the service is covered, PROVIDED THAT there has not been another such consultation within the 5 year period. Exactly like a colonoscopy. Your interpretation makes no sense at all. First, that’s not what the language says. Second, there would be no point in this. What would be the purpose? Saying that someone who got end of life counseling exactly 5 years ago was eligible for further coverage, while someone who got it 5 years and 1 day ago was not eligible. That’s stupid. The 5 year limit is simply to prevent overutilization and fraud. It makes sense for this and it’s precisely analogous to other Medicare benefits which are limited in the number of times you can get them within certain time periods (another good example is nursing home coverage).
Mata, you are totally WRONG on this. I say so. The Bill’s author says so. The language in the bill says so. Independent analysts say so. What you are saying makes no sense (“use it or lose it” for end of life counseling !!!??? That’s utterly and completely absurd, on it’s face and it’s not what the bill says).
Quoting me again:
>>But if they do want their medical provider to advise them about these MEDICAL issues, then the bill says that Medicare will pay the doctor — PROVIDED that this isn’t done more often than every 5 years<<
Well, duhh. That’s exactly what the language says!
No, it’s 100% clear. Especially in the context of established Medicare policy for similar issues (e.g. colonoscopy) and for the reason that your interpretation makes no sense whatsoever.
It’s all part of general end of life counseling which comes up, as I keep saying, most frequently in the context of a cancer patient failing all reasonable chemotherapy. The bill provides incentive for doctors to talk to their patients and explain that additional treatment is more likely to hurt them than to help them, as opposed to merely pushing in more poisons and avoiding the conversation. When you tell a patient that there are no more treatment options, he wants to know what this means and what is going to happen next and what are the issues and options. These take a long time to explain properly. They include both medical issues (for which it is entirely appropriate to compensate doctors) and legal issues (for which they may contact lawyers, who will certainly bill them for their time).
They aren’t the same services! The doctor doesn’t write the living will. He simply understands all the patient’s medical issues, understands what procedures and choices may be most likely to come up and which should be considered for the living will and advance directives. This is in the context of general medical counseling, as described above. So I think it’s great legislation, as it encourages Doctors to sit down and have difficult discussions with patients, as opposed to just pushing poisons and billing Medicare for said poisons.
But you can certainly argue everything on the basis of cost effectiveness. That’s not the issue. The issue here is Sarah Palin killing this legislation by claiming it’s about death panels. She’s an egotistical monster who is out of control and she’s harming thousands of cancer patients. So I’m a stakeholder in this.
But the proposed legislation wasn’t about “death panels!” There’s nothing at all in the language which is a threat to any Medicare patient. Yes, it’s true that Medicare can save money, when toxic and ineffective chemotherapy is not used. What happened is that very responsible legislators looked for ways to improve care, and provide cost savings at the same time. And they came up with a very responsible, compassionate piece of legislation, which also had the virtue of being potentially cost effective.
And a GOP hack decides to play politics, to the disadvantage of patients, by screaming “death panels,” and Palin picks up the megaphone and gets mega publicity for herself while directly harming thousands of future cancer patients. I consider her to be an egotistical monster of a politician. The worst kind of politician. The scaremongering type.
See my explanation, above. Absolutely everything in medicine can be misused. Tests can be misused. Surgery can be misused. Drugs can be misused. Counseling is part of medicine, and it can be misused as well. But it is doctors doing the counseling and doctors have no stake or incentive at all to kill patients prematurely. Doctors make money by providing services to patients, not by burying them.
Look at my post above on prostate cancer (#144). Let’s say that legislation was written to pay doctors to take the time to present all the data and explain the comparative effectiveness of screening versus no screening and surgery versus watchful waiting, so that patients could make informed choices. This would be a very good thing for the patient, in my opinion, and could also save Medicare some money. Sarah Palin could scream that this was an attempt to save money by denying patients potentially live saving cancer tests and treatment. It’s no different.
Oh, this is complete and utter crap. It’s a straw man. As I said, counseling could be misused, as can any other medical service. But there’s no incentive to the physician (who is doing the counseling) to die more quickly. And the language above pertaining to be “required to be counseled about the supposed benefits of killing oneself” are utterly outrageous! You should be ashamed of yourself for quoting that hysterical scaremongering. It’s hateful.
NO, IT IS NOT!! It’s exactly what it says it is: It provides reimbursement to doctors for taking the time to sit down with their patients to explain their medical situation and offer them the autonomy to make their own choices. A death panel makes decisions to kill people. There is absolutely nothing at all in the language of the bill which could begin to justify its characterization as setting up “death panels.”
And the bill was not withdrawn because of fears that it would be implemented incorrectly. It was withdrawn because of the political hysteria created by the shameless scaremogering of Sarah Palin.
1. Any medical procedure has the potential for abuse, leading to the premature death of patients. This proposed legislation has less potential for abuse and harm to the patient than most medical procedures for which Medicare pays. As I said before, there is no net financial incentive to a doctor to hasten the death of a patient. 2. These services are NOT “already provided!” Or, rather, they are greatly underprovided, because busy oncologists and other doctors, being human, don’t want to spend huge amounts of time doing things for which they won’t be paid, when the alternative is simply to go with the flow, provide more worthless and harmful treatment, and collect more money.
~~~
What went into my parent’s living wills were descriptions of which medical procedures they wished to receive and which they didn’t. Such descriptions can be either very simple, or very complex and detailed, depending on the specific clinical situation. It is usually preferable for the doctor to explain what procedures might come into consideration in a given patient’s situation.
.
You specifically said that doctors would be compensated for “estate planning.” No they won’t. They will be compensated for PROVIDING MEDICAL INFORMATION essential for construction of an appropriate durable power of attorney (i.e. what procedures should be part of advance directive — procedures that the doctor can foresee being required and on which the patient wants to decide in advance — and which procedures should be decided at a future time, with the person designated to have the durable power of attorney making the decisions, in the case the patient is incompetent. It doesn’t pay the doctor for writing the legal documents (the patient will still need a lawyer) but it does pay the doctor for providing medical information specific to the patient’s case which are required for informed planning.
The doctors aren’t being paid to practice law or draft legal documents. They are being paid to provide medical information necessary to make informed choices in drafting the legal documents.
No, and the doctor isn’t being paid to provide information about funeral arrangements and credit cards — only for providing medical information. This is 100% clear to everyone, except defenders of Sarah Palin.
The doctors are being paid for providing the overall medical aspects of end of life counseling — for providing counseling for specific medical issues relating to that specific patient, which no “toll free hotlines” are qualified to provide.
You totally don’t get it. Oncologists and other doctors who take care of terminally ill patients should be encouraged to counsel their patients, as opposed to simply performing revenue generating medical procedures on them. As part of the overall counseling, issues such as living wills and hospices come up. The bill was an honest effort to help patients and improve end of life care, which has the added benefit of saving money, when worthless treatments are not pursued. One can, again, have honest differences of opinion concerning the ultimate worth of the bill, to patients, doctors, and the system — but to scaremonger by characterizing the bill as an attempt to set up death panels and promote euthanasia is beyond outrageous, it is truly evil.
- Larry Weisenthal/Huntington Beach, CA
Reply to #150 went to spam.
I am sorry that I wasn’t able to proof check the formatting. I hope that it comes out OK, whenever it is retrieved and posted.
- larry w/HB
Larry, I swear this is my last post on a moot point of badly written, defunct legislation … which is why I was utterly opposed to it to begin with. You insist the law would work as intended, and I point out to you… and by your own admission.. that “intended” laws are abused by attorneys constantly.
If you portend you know how legislation will be implemented, and decided on in a court of law before it’s law, and before lawsuits arise, then so be it. How about a few stock tips for the rest of us, oh omnipotent one?
Yes, they should. And that should also be part of their current job, and not a separate payment for “end of life counseling”. If the patient is told of the types of treatments and their risks/results as part of that physician’s job, they already have enough information to make their informed decisions to take to an attorney to construct their living wills and wishes. You just support an extra charge to do this when frankly, you should be at the forefront arguing that doctors are not doing their full jobs when they do so automatically.
But then, you can’t…. can you? Because you, yourself, told us that the lawyers just don’t interpret that as part of a physician’s job. Must be some other explicitly clear legislation of intent that just doesn’t fly in the courts the way the authors intended, eh?
I do “totally get it”. I do encourage doctors to counsel patients on their options for treatment. Unlike you, I don’t think they should be paid extra for what they should do morally as part of their gig, and wrap up yet another revenue grabber by masking it as “end of life counseling” fee.
You may be correct that the bill was intended as “an honest effort” to make physicians responsible for their jobs. But I’ve never seen legislation make anyone especially due diligent if they aren’t inclined to do that already.
Then we get to Palin’s testimony where she plainly states that with government bureaucrats make medical decisions, it is a death panel… right on the heels of discussing the genuine “death panel”, Obama’s IMAC. I have constantly stated that I didn’t consider the end of life counseling the “death panel”, but I most certainly do the IMAC. Their entire existance is based on cutting reimbursements and coverage in order to keep the budget in line. As costs continue to rise… as will do since there is absolutely nothing built into this socialist utopian dream to reduce costs… trimming the fat and deciding who gets the coverage and who doesn’t is the job of the IMAC.
You read the testimony, insulted me for providing her quotes, then totally misconstrued what she was talking about. Congratulations. As I said, you really must learn to read slower.
Talk about hysterical scaremongering… congrats for that splendid demonstration of such. So Palin’s to blame for “harming thousands of cancer patients” because of no end of life counseling? That’s a hell of a leap, and a despicable transfer of responsibility. If anyone is harming “thousands of cancer patients”, it’s the “wallet oriented” doctors who do not consider it part of their job to counsel them on the risks/results unless they’re paid separately to do so.
I might also point out that Palin holds no power to vote on legislation, holds no elective office, and last I looked, it was Rush Limbaugh who was the head of the RNC per those with your mentality. The fact that you lay every bit of this at her feet reveals an extreme personal bias, an imagination usually found with paranoid mental disorders, and exhibit the quintessential liberal trait of “it’s always someone else’s fault”. Why did not your precious supermajority just keep it in, as they’ve kept the entire BS piece of legislation alive despite public opinion?
Get a grip, Larry. Honestly. You have an unhealthy fixation on a woman with very limited power. What Palin believes or doesn’t want is irrelevant when it’s exactly what Pelosi, Obama and Reid *do* want. Witness this is being pushed thru despite a more than health majority of Americans being opposed… just as we were opposed to the TARP bailout, the ARRA stimulus, the ominous Omnibus and the Cap and Tax. Yet you assume because Palin speaks, the Dems listen and cut it out of their bill? Seriously laughable.
Lastly, let’s not confuse Palin with myself. And I’m really fatigued with you constantly referring to me as a scaremonger… whether for things that I’ve said, or for things others have said. Frankly, Larry, each time you do that, you drop another notch in esteem with your Alinksy style debate tactics. It’s your distinct way of saying STFU. Playing that same game of personal assault, it’s people like you who will be content to be the death of America’s economics… and that’s not something I’m likely to ever forgive merely so you can “hope” for the social medical utopia you dream can happen – despite repeated history of it’s failure.
After 200 some-on posts by Larry, focused on NOTHING but this topic, I am now convinced he’s getting a kickback from the Whitehouse. NOBODY could be this damn adamant about such a losing POS as this bill without having something going on to make it worth it.
Or he’s sneaking meds.
Either way, it’s become pathetic.
Oh, by the way, scratch that 30,000 number of uninsured that Obama whittled down for a speech recently and don’t bother to pay any attention whatsoever to CBO cost estimates:
http://www.nytimes.com/2009/11/14/us/politics/14immig.html?_r=1&hp
That’s why they want this fiasco pushed through before the end of the year or by making this announcement now, they want to put a stake in it.
@mata (#153)
You gotta love the GOP. “Medicare is going broke!” Another “failed” government program.
Dems try to fix it: “Death panels!”
IMAC has nothing to do with death panels; it’s making reimbursement decisions on the basis of transparent, public deliberations (as opposed to private insurance and individual doctors, who make reimbursement and treatment decisions behind closed doors and inside closed skulls).
The “end of life counseling” had nothing to do with death panels; it was about reducing ineffective end of life treatments, improving quality of life at and of life, and also trying to control Medicare costs.
The legislation was good, clear legislation, as written. If there were any ambiguities, it would have been helpful to suggest changes in the language to clarify those ambiguities, instead of screaming “death panels.”
On one hand you maintain that doctors are leaving Medicare in droves, because they are being squeezed financially. On the other hand, you don’t think that a doctor should be paid for sitting down with a patient and telling him that his chemotherapy isn’t working anymore and further chemotherapy is much more likely to shorten his life than prolong his life and it is likely to make him feel worse and that, unfortunately, there are no more promising treatments left in the cupboard and said patient, of course, has lots of questions, and doctor patiently answers all of them and, in the course of this discussion, such things as advance directives and living wills and durable powers of attorney (“medical surrogate”) and hospice care come into it, and doctor explains the technicalities and limitations of foreseeable medical procedures, so that patient can make best informed decisions, and you feel that said doctor deserves no compensation for this, although you are only too happy to see said doctor get compensated for pushing chemotherapy and perhaps performing more futile surgery or giving more futile radiation.
The path of least resistance is just to keep treating, to the end. You get paid more; it takes less of your time; and it’s less stressful on you (no fun, at all, giving end of life counseling).
I have no problem at all with people pointing out ambiguous language, questioning cost effectiveness; taking the position that doctors shouldn’t be paid for thinking and talking but only paid for cutting and sewing and pushing drugs and directing radiation treatments (though the misincentive to provide treatment services as opposed to dispensing advice and counseling is at the heart of some of the most serious problems with the health care system).
You argue that the bill is imperfect and could be improved or isn’t necessary; that’s one thing.
Claiming that it’s about government bureaucrats deciding who’s going to live and who’s going to die and encouraging doctors to withhold effective treatment for the purpose of getting patients to die faster — that’s despicable.
And all Palin cared about was raising her profile, at the expense of tens of thousands of cancer patients. What she did was utterly despicable.
- Larry Weisenthal/Huntington Beach CA
@mata: Sigh, reply to #153 went to spam.
- Larry W/HB
@patvann:
#1. I am a medic; so, of course, it’s the issue most important to me. Some on this blog only post on national defense or terrorism issues.
#2. You haven’t been around long enough. When I have the time and interest and when it’s topical, I like to debate economics, climate change, foreign policy, whatever.
But thanks for counting my posts. Nice to know that I’ve got such a loyal follower.
- Larry W/HB
Sorry Larry, I didn’t realized there was nothing else going on on this site, or even the planet important enough for you to avert your gaze. Hell it doesn’t even matter to you WHICH health payment-plan is at the fore, you support all of them, facts be damned!
Some “medics” might call it obsessive-compulsive.
Never once have I suggested that it was about doctors withholding treatment, encouraging patients to die faster. You put words into my mouth that I have never uttered. And that, Larry, is despicable. Again, you confuse me with someone else.
You totally misunderstand the IMAC legislation. Or perhaps you’ve never read it, as it’s a side bill with little fanfare. Have at it… Here’s the last proposed text I have. It is all about their power to recommend adjustments to reimbursements for everything from services to hospice care, prostetics, etal. When they cut percentage reimbursements, what exactly do you think happens to the insured patient… as well as the medical providers?
You say:
100% wrong, as you like to say. There is nothing public about the 5 man appointed panel, working behind closed doors with their recommendations first being reviewed by the Chief Actuary of the Centers for Medicare & Medicaid Services, and then passed on to the POTUS for approval. It can then only be reversed if the Senate can pull together a joint resolution within 30 days noting disapproval.
Yeah… real “transparent”, Larry.
As far as leaving Medicare in droves…. as I said, doctors should do this as part of their job. Period. I’m not going to argue that point any more, nor acquiesce that a way for them to pad their under cost reimbursements via an end of life counseling fee is the answer to service shortages. Fact is, real “reform” would be for better prices on equipment and supplies so their costs weren’t skyrocketing, or full reimbursement for their equipment and supplies. But add on extras to pad the loss is absurd.
If doctors choose “the path of least resistance” because it’s more money and less time consuming, *they*, not Palin, are the culprits. You blame her for their wallet mentality. That makes you despicable, and succumbing to the irresponsible shifting of blame, or the “it ain’t my fault” mentality. That is sheer, arrogant chutzpah.
@mata (#160): There’s nothing tremendously wrong with IMAC, as proposed in the language of the document you linked. They are just setting broad reimbursement formulas for major classes of procedures. They are not doing detailed adjustment of individual drugs, operations, diagnostic tests, etc. They are not deciding which patients get treated and which don’t. They are a mixed panel of experts, from both political parties. They are very analogous to the Federal Reserve, only they are accountable to both President and the Senate. They are certainly nothing like a death panel. Neither is anything relating to the end of life counseling stuff, as we’ve discussed previously.
If IMAC, the President, and the Senate set reimbursements too low, providers will drop out and they’ll have to increase levels.
As I wrote, the GOP screams that Medicare is failing; George Bush only made the Medicare problem worse. Obama is trying to fix Medicare, so that it will be available for all of us, and Palin and her supporters scream “death panels.” Which is despicable scaremongering by despicable people.
I never accused you of being one of those screaming “death panels.” I do argue stridently against the people who did that and against those who defend them for screaming “death panels.”
You can moralize or you can try to fix a very big problem. You think that doctors in private practice should be paid for doing surgery and pushing poisons and directing ray guns but not paid for counseling, which is, in the situations we are discussing, far more efficacious, to say nothing of far more humane. You expect altruistic standards of doctors which are found nowhere else in capitalist society, and, when those standards are not met, you support those scaremongering with accusations of “death panels,” as opposed to those who try to come up with real world solutions to previously-intractable problems.
How do you propose to encourage more counseling and less ineffective treatment? Threaten physicians with incarceration?
It’s good legislation which was killed by “Pants on Fire,” lying scaremongering.
- Larry Weisenthal/Huntington Beach, CA
Nothing earth shaking here Larry.
One would have to be living under a rock not to recognize that the ‘ current’ GOP could give a crap about social issues, especially abortion. They “tolerate” and “talk the talk” for the simple reason they can’t win without the social conservatives. If they could win without us, we would be “under the bus” in no time.
On the other hand, many of them feel secure in their “big tent” theory, assuming the social conservatives have no where else to go. I predict Sarah Palin will change that, and continue my prediction from a year ago that if Palin runs for POTUS, it will NOT be with the GOP.
Abortion is a CONSERVATIVE issue, not to be confused with the GOP.
Larry, all you really keep saying is it’s for our own good.
Mata, thank you for taking the time to show how wrong larry is. Your knowledge of the proposals is very impressive.
@ Hard Right
What Mata has provided in this regard, is nothing short of breathtaking.
Patvann, for once I didn’t want to needle larry. Since you did, I MUST agree. Breathtaking indeed.
And what would you describe the Hippocratic Oath as but altruistic?
In case you don’t remember, Larry… the text of the Hippocratic Oath from the Harvard Classics translation
hummmm… I wonder if those evil Wall Street CEOs have a similar oath
BTW, Larry… I want you to ponder your statement below carefully, and let us all know how it differs from Palin’s comment that such counsel is a subtle encouragement to end your life earlier in order to save government costs:
For a brief scroll refresher course, let’s compare that with what Palin quoted Eugene Robinson (o’healthcare supporter) said… where that “scaremonger”, “despicable” Palin thoroughly agreed. Again, from her testimony text:
So… this “scaremongering” differs from your statement HOW?
Mata good luck with the Hippocratic Oath argument. Most MD’s never even take it anymore.
Between Ezechiel Emanual on record of “we take it too seriously”, to the Julie Cantor’s (MD, JD) op-ed in the NEJM advising any physician who has a problem with “anything legal” to best go into podiatry, it’s a mute point, gone the way with our moral decline.
Cantor’s rant was more focused on the Bush Conscience clause but in the end, all one in the same.
Touche’ Mata…… you called that one dead on!!!
Seems too many times it’s not WHAT was said …..as opposed to WHO said it!!
@Mata:
#167,168:
Here’s the difference, Mata:
Here’s what Palin said:
This is scaremongering. What I wrote was factual, sensible, and not scaremongering. With respect to Mr. Robinson, what he was pointing out was the need to educate the public. Remember, the “dialogue” which was supposed to take place at those Town Hall meetings where, instead, the Senators and Representatives who came their to explain the legislation and answer questions were, instead, shouted down by citizens whipped into a frenzy by Palin’s irresponsible and dishonest scaremongering.
Regarding my quote (above): There are two huge problems, which are related to each other.
The first problem is runaway, unsustainable health care costs. 16% of GDP, headed up to 33% of GDP. Small business (“the engine of the economy”) health insurance premiums rising this year by 15%, at a time when there’s 11% unemployment and virtually no inflation in the rest of the economy. Medicare on a path to insolvency. Somewhere between 25 and 30% of Medicare expenses are for patients in the last year of life. Half of all people surveyed say that, were they to have a chronic, terminal illness, they’d prefer to die at home, rather than in the hospital.
http://content.healthaffairs.org/cgi/reprint/20/4/188.pdf
Hospice care is often the choice of patients and families, when the patients can no longer be cared for at home. Hospice isn’t a one way street for poor people who can’t afford private duty nurses at home. Art Buchwald entered a hospice, stayed there 5 months, and then left, when his kidney failure stabilized.
However, all of the financial incentives today in medicine are for performing diagnostic tests and providing active treatments, even in the frequent situations (e.g. terminal cancer) where treatments are toxic and more likely to hurt than to help.
So you’ve got a situation which cries out for reform. The reform proposed was simple and humane. Pay doctors for counseling patients, as doctors are currently paid for treating patients. The amount of money that doctors would get for counseling would still be a fraction of what they’d get for treating, but it would be at least something, and I believe that it would lead to more counseling.
I’ve explained the “rules” of the counseling previously and I’ve explained how you were not correct to claim that this counseling was ever intended to be “mandatory” or that it could ever be possibly construed to be “mandatory” by anyone familiar with Medicare reimbursement rules.
With regard to the Hippocratic OathL
You don’t understand this any better than you understood the proposed legislation regarding end of life counseling:
Mata, the above quote says this:
“him who taught me this art” refers to one’s mentors and professors. One is obligated to provide all necessary care to one’s mentor (the person who was the teacher to said doctor) and to teach the offspring of one’s mentor the art of medicine, should said offspring wish to learn it. And such teaching must be provided without fee or stipulation, meaning that I am supposed to train my mentor’s children in the art of medicine without charging them tuition. Furthermore (it continues) I promise to train my own sons in the Art of medicine as well as the sons of my teachers, and to other students who agree to be bound by the law of medicine, but not to train students who do not agree to be bound by the “law of medicine.”
The above says nothing at all about providing medical services without compensation; it only says that must agree to train the sons of their own mentors “without fee or stipulation.” Would that this were true today; I’ve trained a fair number of medical students and interns and residents and fellows, who today are excellent physicians. It would be nice if they would agree to train my own offspring for free, to spare the necessity of paying $45,000 per year in tuition and fees.
Continuing:
Yes. Hear hear. But here’s the rub (following is a quote often cited by oncologists):
One can almost always justify pushing more chemotherapy. Or even doing another surgery or radiation treatment. I saw an interesting study presented at the recent (October) American Society of Clinical Oncology breast cancer meetings in San Francisco. They did a survey of patients and oncologists and asked each group how long a life prolongation would be required to make chemotherapy “worth it.” It was quite interesting. The large majority of oncologists felt that a 2-4 month life prolongation was “worth it.” More than half the patients required at least a 10 month life prolongation to be “worth it.” But about 15% of patients said that even a one month life prolongation would be “worth it.”
So what needs to be done is to take the time to have a conversation with patients — telling them the facts, and, if the facts suggest that one alternative to consider is to stop receiving chemotherapy, to then be prepared to spend as much time explaining the alternatives as is necessary, and this includes considerations such as living wills and possible hospice care. Again, there will never be a net financial (or emotional) incentive to the doctor to withhold potentially beneficial treatment in any case, and counseling about living wills and advance directives is often appropriate, even when the decision is made to continue treatment.
As I have repeatedly stated, it’s legitimate to argue over language and details, but it’s a travesty to claim that this would involve death panels, and it was inaccurate of you to claim that end of life counseling would be “mandatory” and to claim that the legislation contained a coercive “use it or lose it” provision.
- Larry Weisenthal/Huntington Beach, CA
@mata (#166,167,168) My reply went to spam. Again, I won’t have the opportunity to check formatting or revise if it doesn’t display or read properly. I want to make sure that the block quotes and “strongs” are in the right place — maybe someone can look it over and correct the formatting, if I got it wrong. – Larry W/HB
Pingback: The Baltimore Reporter
Does anyone really realize from where the word “Behemoth ” comes from? Behemah in Hebrew is a beast (untamed and wild) or a form of monster! Behemoth is actually the translation of “many beast” from Hebrew! That is exactly what we are looking at here! Thank you Curt! Good write up! Good comments as well!